Action Points

Explain to patients that this study suggests that physical activity may help offset the heart risks associated with large body size.

Note that the findings came from a study of former professional athletes and might not apply to other populations.

Note that this study was published as an abstract and presented as a poster at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

NEW ORLEANS, Nov. 13 -- Retired National Football League players, though considerably heftier than the norm, had significantly better heart disease risk parameters than a matched set of community controls, according to researchers.

The former NFL players, who were significantly less likely to be sedentary than controls, had a lower prevalence of diabetes, hypertension, and metabolic syndrome, reported Alice Y. Chang, M.D., of the University of Texas Southwestern Medical Center in Dallas, at the American Heart Association meeting here.

Of 151 former athletes and 150 controls who had coronary calcium assessments, the ex-players were taller (187 versus 175 cm) and heavier (111.3 versus 96.3 kg), but the median body mass index was about 31.5 in both groups.

However, the retired athletes had a higher prevalence of hypercholesterolemia and impaired fasting glucose.

"First, being a professional athlete doesn't protect you from developing heart disease later in life," said Dr. Chang. "Secondly, remaining physically active may help protect against many of the health risks of large body size in former competitive football players."

The investigators found that "age and hyperlipidemia, not body size, were the most significant predictors of subclinical coronary atherosclerosis among retired NFL players."

The case-control study involved 201 former NFL players, who completed a health questionnaire and visited screening sites in Dallas, Atlanta, Miami, and San Francisco. The participants included recent retirees and older retirees.

The mean age of the group was 55, and 59% of the former players were African Americans. Linemen (typically the largest players on a team) accounted for about 30% of the group. These results were not significantly different when controlling for ethnicity or linemen status.

The retired players were compared with a control group drawn from two prospective cohort studies.

Screening evaluations for the former players and the control group included height, weight, waist and hip circumference, and blood pressure; fasting blood glucose, lipids, and C-reactive protein; and coronary artery calcification assessed by computed tomography.

Dr. Chang and colleagues found significant differences between the former players and control group with respect to:

Sedentary lifestyle - 35% of the players versus 49% of the control group (P<0.05)

Diabetes -- 4.6% versus 17% (P<0.01)

Hypertension -- 38% versus 60% (P<0.01)

Metabolic syndrome -- 34% versus 46% (P<0.05)

Impaired fasting glucose -- 45.8% versus 23.8% (P<0.01)

Hyperlipidemia -- 42.2% versus 9.5% (P<0.01)

Smoking history (current or former) -- 30% versus 56% (P<0.01)

Despite being much larger and heavier, the former NFL players had a prevalence of significant coronary calcification (46%) similar to that of the control group (48%). On the other hand, the players had a lower overall prevalence of heart disease risk factors, which apparently afforded no protection against atherosclerosis.

Larger body size might have made them more prone to hypercholesterolemia and prediabetes. Staying physically fit might have offset the risks associated with body size, said Benjamin D. Levine, M.D., also of UT Southwestern.

"The prevalence of obesity, using normal criteria is really high when you look at NFL players," said Dr. Levine. "However, BMI is only a crude measure of fatness. For the athletic community, it may be biased against very dense, muscular people who have a high BMI but not much fat. The BMI might not tell the whole story."

Dr. Levine also noted that the study was based on retired players from a different era. Current NFL players are about 50% larger than those of a quarter century ago.

Whether current or former NFL players have an increased risk of cardiovascular disease or death requires longer follow-up of more players.

The study received support from the AHA, the NFL Players Association, the NFL Alliance, and from several additional nonprofit organizations.

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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